Predictors of HIV -test completions by drug users: A randomized trial of home -collection test kits and clinic -based testing

Abstract

In the year 2000, over 23,000 HIV tests were conducted in Philadelphia. Only 45% of those tests were “completed” in the sense that people obtained their test results. Early diagnoses of HIV presents opportunities to treat people who are infected, educate them, and prevent infections. For this reason, evaluating approaches that could increase test-completion rates is important. This study compared HIV test-completions using two modes of testing: a home-collection test kit (HC) and clinic-based and testing (CB). Participants were recruited from three programs serving drug users in Philadelphia. Nearly 500 eligible people [methadone treatment (n = 159); detoxification (n = 196) and syringe exchange (n = 134)] were randomly assigned at each program to either HC or CB testing: Rates of test completions by test type and by recruitment program were assessed using χ2 tests. Test completions were predicted using logistic regressions. Self-report and independent-confirmation of test completions were examined. Overall, more people in HC reported test completions (HC = 57%; CB = 45%). Independent confirmations of test completions were also higher in HC (HC = 50%; CB = 35%). Across the three programs HC had higher completion rates: detoxification (HC = 44% and CB = 33%), methadone maintenance program (HC = 54 and 41%), syringe exchange (HC = 81% and CB = 64%). Logistic regression predicting test completions showed that people with no history of testing were less likely to complete testing compared to people with previous testing. Compared to people in methadone maintenance, syringe exchange users were more likely to complete testing and people in detoxification treatment were less likely to complete testing. Findings from this study suggest that home-collection testing increases test completions relative to clinic-based testing across programs serving drug users. Of people who used HC, 64% stated they preferred HC for future testing; 41% of people who used CB preferred CB for future testing. The distinct preference coupled with higher rates of test completions for HC among these drug users suggests that the HC technology can help to increase HIV test acceptability and completion rates among users. ^